Thesis project of Dave Walton PT, PhD(cand.)
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To develop a new tool for use with acute WAD
patients that:
1. Is clinically feasible
2. Provides an estimate of the risk that a patient will
develop persistent WAD-related morbidity
3. Indicates the nature of the risk, focusing on
modifiable barriers to recovery, that will help in
clinical decision-making
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2006 – 2007: Systematic review and metaanalysis of existing prognostic literature
(JOSPT Fall 2008)
2007: Construction of multi-dimensional
model for the development of chronic WAD
2007-2008: Development of the prototype
tool using the model as a framework for item
generation.
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Items were generated by 5 physiotherapists
with experience in treating WAD (mean
clinical experience 12 years, range 8-18)
Well over 1000 items generated
Items reduced through group consensus and
theoretical considerations
Items passed by experts from other fields
(psychology, physiatry, questionnaire
development)
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Tool now consists of two parts
1. 93-item self-report questionnaire
2. 19-item physical assessment
Self-report questionnaire reviewed and
edited by professional technical editor
Pilot testing:
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Questionnaire: good acceptability so far,
average of 15-20 mins to complete
Physical ax: reliability testing currently
underway
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Self-report questionnaire:
◦ Multiple sub-constructs hypothesized to predict
multiple outcomes within the spectrum of ‘WAD’
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Symptoms
Coping strategies
Cognitions
Emotions
Past history
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Physical assessment:
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ROM (ordinal)
Peripheral key muscle strength (nominal)
Reaction to traction/compression (nominal)
Neck flexion in supine (ordinal)
Sensation (nominal)
Algometry (ratio)
Symptom reproduction (for each)
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Recovery at 3 and 6 months post injury,
defined as:
◦ Not all bothered by symptoms over past week
◦ No interference with normal activities over the
past week
◦ Very satisfied with current situation
◦ No ongoing medication use for symptoms
◦ Return to full work or school (not included for
those unemployed or not in school)
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Neck Disability Index (10 items)
Core Whiplash Outcome Measures (5 items)
Patient Health Questionnaire (9-item
depression screen)
PTSD Checklist (17-item PTSD screen)
Tampa Scale for Kinesiophobia (11-item
fear/avoidance screen)
Other individual items (bothersomeness,
ongoing litigation)
65 items in total at follow-up
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Subjects who meet inclusion criteria are
presented with the LOI and consent form at
their first visit.
Those who consent:
◦ Name and contact info is recorded on a master list,
associated with an ID number
◦ Given the prototype self-report questionnaire to
complete within 24 hours
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Completed forms are sealed in an envelope
and returned to clinic staff for storage
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Standardized physical assessment is
completed after subjective interview but
before more targeted assessment techniques.
Findings are recorded and stored securely
with self-report questionnaire.
Master list must be stored in a locked cabinet
with consent forms at night
Completed forms must be stored in a
separate locked cabinet
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After either a) 10 completed forms have been
collected OR b) once per month, completed
forms (not master list) are sent to Dave
Walton at UWO via Purolator (pre-paid).
Once per month master list is faxed to Dave’s
private fax machine.
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At therapist’s discretion.
We are not trying to control anything to do
with intervention (good external validity,
some sacrifice of internal validity)
We will ask you to complete a checklist of the
general types of treatment provided, at either
D/C or 6 months, whichever is first. This can
be mailed or faxed.
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Arranged by Dave and/or research assistant,
you don’t do anything regarding follow-up
for the study. The process will be (FYI only):
◦ We will either mail the forms to the patient’s house,
or email the patient a link to a secure site with the
forms online.
◦ Forms are completed and either mailed back to
Dave, or stored on secure server.
◦ This is done 3- and 6-months post-injury (approx.
15-20 minutes to complete)
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Data!
◦ Clinics who see WAD patients post-MVA within 4
weeks of injury
◦ Clinicians who are willing to learn and perform the
standardized assessment on patients at their first
visit (pretty straightforward)
◦ Clinics with staff who are willing to:
 Screen potential subjects for inclusion criteria (w/i 4
weeks of injury, at least 18, able to read English)
 Provide the LOI, consent form and questionnaire
 Keep a master list and consent forms in a locked
cabinet
 Fax the master list to Dave once/month
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530 total subjects
As many clinics as are interested
Ethics approval and data collection to start in
May ‘08
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All the forms, including questionnaires, master
list with pre-generated ID numbers, envelopes.
Instructional manual and video for performing
physical assessment
A digital algometer and set of monofilaments for
sensory testing, for the clinic, as long as you act
as a data collection site
Recognition as a data collection site (certificate)
That warm fuzzy feeling that comes from
contributing to research in the field
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Dave Walton PT, FCAMT, PhD(cand.)
Dr. Joy MacDermid PT, PhD
Dr. Robert Teasell MD
Dr. Warren Nielson, Psychologist, PhD
Jennifer Toland PT, FCAMT, MClSc(cand.)
Hilary Reese PT, FCAMT, MClSc(cand.)
Tamara Nailer PT, MClSc(cand.)
Lenerdene Levesque PT, FCAMT, MClSc(cand.)
The forms, including assessment manual, and
more information, are available on-line at:
http://publish.uwo.ca/~dwalton5/Website
Or, contact Dave at:
dwalton5@uwo.ca
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Thanks!
Whiplash, the
cowboy monkey